Timing of Surgery and Medical Optimization in Multisystem Trauma: A Systematic Review of Outcomes Based on Internal Medicine Co-management With Orthopedic, Neurosurgical, Vascular, Thoracic, and General Surgical Emergencies

Abstract

This systematic review explores the impact of internal medicine co-management on surgical outcomes and timing in adult patients across various surgical specialties, with an emphasis on trauma care. A comprehensive literature search identified five eligible studies comprising over 60,000 patients. Co-management models included hospitalist-led, advanced practice clinician-led, and multidisciplinary approaches. The outcomes consistently showed reductions in complications, hospital length of stay, rapid response team activations, and 30-day mortality. One study also highlighted indirect timing benefits, such as reduced intensive care unit (ICU) stay and ventilation days, with earlier surgical intervention. Although the evidence base is limited by study heterogeneity and lack of randomized trials, the consistent positive trends suggest that structured co-management enhances perioperative safety and system efficiency. These findings support broader implementation of co-management models, particularly in high-risk surgical and trauma populations, and underscore the need for further prospective research targeting surgical timing and interdisciplinary coordination.